Game-Changer: Alessandro Nanussi and the Art of Sports Dentistry

In this exclusive interview with Dr Alessandro Nanussi, a passionate and prominent voice in sports dentistry and gnathology, we inquire about the various initiatives, programmes and sporting events that he has participated in to advance this vastly underrated field.

By Danny Chan

This year’s Six Nations Championships in rugby presented an excellent occasion for Federation Dentaire Internationale (FDI), the international organisation representing the worldwide dental community, to showcase the vital importance of oral healthcare for all athletes. 

Through the promotion and dissemination of the FDI Sports Dentistry Toolkit and Guidelines, the August body took the opportunity to promulgate an oft-neglected fact: How inadequate oral health can significantly affect an athlete’s performance. Professional rugby players are not the only athletes susceptible to oral health issues, although they are generally considered more prone to dental injuries, which can disrupt their training and performance. 

Offering essential tips for athletes and sports organisations to enhance athletes’ oral health and overall performance, the FDI Guidelines represent a concerted effort by oral health scientists, sports dentists and gnathologists – a highly qualified group of unsung heroes that the general public often takes for granted.

Dentist Behind Your Sporting Heroes

In this Q&A section, we bring to your attention one such hero, whose life’s work and research revolves around sporting-related traumas such as dental fractures or jaw dislocations, along with issues like malocclusion, that can influence various aspects of an athlete’s performance, including posture, balance, and sleep.

Graduating in Dentistry back in ’93, Dr  Alessandro Nanussi ventured into the domain of Sports Dentistry, earning a post-graduate degree in 2008. His fervent passion and commitment to the field led him to become the Past-president of the Italian Society of Sports Dentistry (SIOS). He currently holds the position of Vice President and is set to lead as the President in 2022 for the Italian Association of Gnathology (AIG).

Hailing from Milan, Italy, Alessandro Nanussi practices his craft as a freelance dentist at Studio Skysmile, where he partners with Professor Cristian Coraini. Here, he plays a pivotal role as the Referent of the Sports Odontostomatology Service and Cranio-mandibular Biomechanics at the esteemed Italian Stomatological Institute of Milan.

Beyond the Dental Chair

Alessandro’s contributions extend well beyond his dental chair. At the University of Milan-Bicocca, he serves as an adjunct professor, imparting knowledge on statistical analysis of epidemiological data. He’s also the driving force behind the Elective Course “Analog and virtual articulators” and a professor of sports dentistry. Until 2018, he was responsible for the internship of Gnathology and has been a dedicated teacher and tutor at the Master of Orthodontics and Gnathology.

He also teaches instrumental analysis for the Master and Specialization Course in Sports Dentistry at University of Chieti-Pescara. At the SOMA Osteopathic Institute in Milan, Dr Nanussi spearheads the course of Clinical Dentistry and Gnathology and contributes to the post-graduate course in temporomandibular dysfunction.

Alessandro Nanussi is not just an educator but also a passionate advocate of spreading knowledge. He regularly shares his insights as a speaker at courses and conferences on international platforms. He is also an accomplished author, having penned numerous publications. 

In collaboration with Professor Cristian Coraini and Mr. Luca Vailati, he received the prestigious International Occlusion Award at the 15th ICP World Congress in 2013.

Involvement in the International Sporting Arena

Alessandro’s commitment to sports dentistry goes beyond theory and academia. He has actively contributed to major sporting events, including the Turin Winter Paralympic Games and the Giro d’Italia of cycling. His influence extends to co-authoring the book “Dentistry and Sport,” published by Edi-Ermes.

Alessandro Nanussi’s relentless pursuit of excellence, combined with his deep-rooted passion for sports dentistry and gnathology, has not only elevated the field but also inspired countless sporting professionals to strive for greatness – resting in the knowledge that their oral health is in good hands.

Q: Can you tell us about your journey in the field of dentistry and how you developed an interest in Sports Dentistry and Gnathology?

I have always been interested in global patient health. Before enrolling in the Faculty of Dentistry, I attended the Faculty of Aeronautical Engineering and was fascinated by the management of forces, particularly in dealing with overloads. Athletes represent the epitome of stress on the locomotor system, both physically and biochemically, of which the stomatognathic system is a crucial part. 

Excessive loading can lead to gnathological issues. Therefore, strategies for managing forces have proven to be invaluable in the treatment of dysfunctional patients and in gnatho-orthopaedic and prosthodontic rehabilitation.

Q: As a past-president of the Italian Society of Sports Dentistry and the Italian Association of Gnathology, what were some of the key achievements or initiatives you undertook during your tenure?

In Italy, Scientific Societies hold a prestigious position. They are consulted by the government, particularly through the Ministry of Health, and actively contribute to the development of guidelines in their respective fields. 

These societies represent a form of scientific culture that extends beyond the university realm, although many of their members are also professors. Therefore, holding the presidency is not only an honour but also a means to be socially beneficial. 

It is gratifying to play a role in shaping the regulations governing my daily clinical practice and to share these insights with colleagues through courses (for clinical protocols) and congresses (for cutting-edge research).

Q: Could you share with us your experience co-founding and being on the board of the International Academy of Innovative Dentistry (IAID) and the European Association for Sports Dentistry? What is the mission and vision of these organisations?

Regarding IAID, it’s not a “membership-based” academy; hence, it’s free to collaborate with affiliated international academies from various Dentistry fields. It doesn’t follow the conventional model of an academy that specialises in limited topics separately. Instead, it takes a comprehensive approach, covering all Dentistry topics that involve innovative technologies, including those related to the functional approach, which is my particular area of expertise.

We also provide lectures and instruction on the use of Microscopes, lasers, CAD-CAM technology, Cone-Beam for 3D diagnosis, electromyography, real 3D jaw movement, and occlusal scan-load. These teachings are not limited to one specific field but rather aim to explore the diverse applications of these incredible technologies in General Dentistry. This encompasses Paediatric Dentistry, Orthodontics, Conservative Dentistry, Prosthodontics, Endodontics, Periodontics, Implants, and Gnatology whenever possible.

The European Association for Sport Dentistry shares a similar mission but focuses on international-level projects with the collaboration of scientific societies from various European countries. 

We recently published a proposal for an international oral health screening of athletes, in which I contributed to the gnathological evaluation.

Experiences gained from supporting international sporting events have underscored the significance of this field, although there is still much work to be done in raising awareness among medical organisers at all levels of competition about the importance of preventative stomatognathic care, respecting both function and quality, because trauma therapy remains a top concern.

Dr Alessandro Nanussi

Q: What are the primary focuses of your work at Studio Skysmile Nanussi-Coraini in Milan, and how does it contribute to the field of Functional Dentistry, Orthodontics, and Therapy?

In our clinic, in collaboration with my colleague, Professor Cristian Coraini, we offer a wide range of dental disciplines. This is made possible by the diverse specialisations of the two owners, the valuable assistance of our associates, access to state-of-the-art equipment (ranging from microscopy with up to 200x magnification to condylography with electromyographic support), and close collaboration with various professionals, including aesthetic doctors, physiotherapists/osteopaths, psychologists, and nutritionists.

The primary mission of our clinic is to safeguard the patient’s health, while also preserving and enhancing the functionality and aesthetics of the stomatognathic system by maintaining and improving its anatomical condition.

Q: You mentioned your involvement in the Turin Winter Paralympic Games and the Giro d’Italia of cycling. How does Sports Dentistry come into play during such major sporting events

Sports dentistry, as previously mentioned, involves working with individuals who push their bodies beyond typical physiological limits. These athletes require a state of exceptional health to achieve peak performance while ensuring safety. 

Experiences gained from supporting international sporting events have underscored the significance of this field, although there is still much work to be done in raising awareness among medical organisers at all levels of competition about the importance of preventative stomatognathic care, respecting both function and quality, because trauma therapy remains a top concern.

It’s essential to remember that besides professional and competitive athletes, there are also numerous amateur sports enthusiasts who strive for satisfying performance and overall health and well-being. 

The protocols developed for managing these intense physical stresses, while protecting athletes without compromising their physical capabilities, have proven highly valuable in everyday clinical practice for regular patients. This is because they acquire skills that promote the prevention of complications in the many high-risk situations that can arise in our profession.

Numerous clinical examples illustrate the striking similarity between the muscle recruitment capacity of professional athletes, which can be up to ten times higher than that of an average person, and the forces exerted by individuals undergoing grinding or other significant lever situations (e.g., prosthodontics on fixtures) or facing occlusal instability (during orthodontic treatment). 

The use of instrumental measurement for managing occlusal loads and muscle and joint overloads can be remarkably beneficial.

Q: Being a teacher at the SOMA Osteopathic Institute in Milan, responsible for courses on Clinical Dentistry, Gnathology, and temporomandibular dysfunction, what is the significance of these subjects in the broader context of dentistry and patient care?

Teaching gnathology to osteopaths and collaborating with them in the functional management and symptom therapy of patients, along with a practical and expedient psychological approach, has led to the development of comprehensive, multidisciplinary protocols. These protocols aim to maximise the likelihood of therapeutic success. The predictability of the prognosis hinges on a precise diagnosis that doesn’t prioritise a single treatment area but rather identifies priorities within a multifactorial context. A good occlusion, in essence, is one that is seamlessly integrated into a more intricate physical, neuromuscular, and emotional system.

The protocols developed for managing these intense physical stresses, while protecting athletes without compromising their physical capabilities, have proven highly valuable in everyday clinical practice for regular patients. This is because they acquire skills that promote the prevention of complications in the many high-risk situations that can arise in our profession.

Dr Alessandro Nanussi

Q: What are some of the most exciting advancements or developments you foresee in the fields of Sports Dentistry and Gnathology in the coming years?

I believe that clinical analysis has been standardised for many years (the international Diagnostic Criteria for DCCM are available online), and there are no anticipated advancements in this regard. 

The real innovation lies in fostering interdisciplinary dialogue and embracing translational medicine. This involves conducting patient assessments as part of a multidisciplinary team with various specialists who share a common language. 

The emphasis is on rapid protocols that do not burden the process with an excess of unnecessary and costly information during the initial screening. This approach leads to the “hypothesis of diagnosis,” which can then be confirmed through specific instrumental investigations, thereby avoiding over-treatment.

Q: As an author of international publications, could you share with us some of your recent research interests or projects that you find particularly intriguing or impactful?

There are international clinical guidelines, which are supported and shared by the FDI, providing essential guidance for the management of prevention and trauma. However, many methods for normalising the athlete’s oral environment, both biochemically and bacteriologically, remain unofficial.

Our research, conducted in collaboration with the University of Milano-Bicocca, Perugia, Chieti-Pescara, and the SOMA Institute of Osteopathy, underscores the interdisciplinary functional relationships. It demonstrates that a system can be subjected to demands beyond its capacity to adapt, potentially leading to a critical situation in which functional and cause-effect correlations become evident. These correlations serve as the foundation for developing effective and non-redundant therapy protocols.

Conversely, if neuromuscular and articular functions (both local and general), along with biochemical, bacteriological, and emotional aspects, are respected, the patient is less likely to reach the threshold at which symptoms manifest.

Q: What advice would you give to young dentists aspiring to specialise in Sports Dentistry and Gnathology? What steps can they take to excel in these fields?

Gnathology is not a specialisation; instead, it’s a discipline that should be familiar to specialists across all dental fields. 

It proves valuable in everyday practice by teaching us to operate within the patient’s adaptability limits and manage potential consequences that may arise due to symptoms or overload-related failures. 

For a young colleague well-versed in sports dentistry, this knowledge not only leads to a pleasant and stimulating work environment but also involves the application of advanced functional analysis and the incorporation of relevant protocols into their daily practice.

Q: Finally, what are your future goals and aspirations in your career? Are there any new projects or initiatives that you are looking forward to working on?

In my future, I envision complete immersion in the virtual environment, aiming for seamless integration between the clinic and technology. This integration would feature user-friendly workflows and a genuinely beneficial and rewarding interdisciplinary group approach. These protocols are not only effective but also straightforward to convey, contributing to the success of our courses, whether in private or academic settings, and encouraging further research and publications.